Question:
is the laparoscopic surgery the shortest surgery
and the one that presents the least risk of complications? Why would anyone want an 'open' surgery as opposed to one done by laparoscopy? Sorry for my ignorance! — vitoria (posted on June 23, 2004)
June 23, 2004
No need to apologize, no ignorance in your question. There are actualy a
few different answers to yur question. Some insurances do not cover
Laparscopic surgery they deem it "experimental
"investigational" surgery". Sometimes the surgeon cannot do
the surgery laparscopically for whatever reason. I had Adjustable Lap Band
surgery and I signed a paper that if once the surgery began, the surgeon
found it was not possible to perform the surgery Laparscopically, he would
continue with an "open" surgery. Luckilly, ther were no
complications and I had it done laparscopically. I do know someone who had
RNY and her insurance would only cover it "open". Hope this
helps!
Good Luck!
Sherry S
— sac287
June 23, 2004
With open, you are under anesthesia a shorter amount of time and with open
the surgeon can see better to perform the surgery. Also with open, the
recovery is harder for some since there is a big incision instead of 5
smaller ones. I had lap, no complications, but I'm a wimp and found it
painful, though I had 2 caesareans prior to WLS and found them less painful
than lap RNY. Go figure.
— Yolanda J.
June 23, 2004
Actually, during my research I found out that laparoscopy was safer. The
surgeon can see things much better as he is able to magnify everything,
this gives him a much better view of your organs. Also, the recovery time
is much shorter. I went home the next day and never needed pain meds! I was
amazed because I am such a wimp! ANyway, both are safe as has been proven
thousands of times so my thoughts are, as long as you are able to have the
surgery it doesn't matter! It is life changing!
Good luck!
— sunkissed kid
June 23, 2004
I seeked out lap, because I had a couple of people who I knew that had open
and had problems with hernias. The risk of herinias is far less with lap.
My surgeon does 98% of his WLS lap. However I was told that lap would be
converted to open if the surgeon was not able to "see" or
"get-around" my liver OR other complications that deemed me to be
opened. MO's usually have enlarged livers and this will impede the
surgeon. Also some MO's are not able to have lap because of body mass. I
have a friend who is having lap done in July and the only way her surgeon
would do LAP is if she lost 40 pounds. If she gains any of it back -- she
will be an open. The "off-work" time for open is typically 6
weeks, lap is typically 2-3weeks. These are just guidelines--your surgeon
will be able to provide more details and info. My choice was LAP. Good
luck!! Lisa
— LisaL.
June 23, 2004
A while back, I did a little unscientific research concerning the post op
complications of both. (again, VERY unscientific). It seemed whenever
someone would mention someone having a leak or being hospitalized with
severe complications post op, they had had lap surgery. My understanding of
one important difference is that with an open surgery the surgeon will
staple the stomach, separate the two sections (if being transected) and
then oversew all of the edges. With a lap surgery, the surgeon isn't able
to perform this important second step of oversewing. Therefore, a leak is
more likely to happen with a lap procedure. Now, a leak is very rare, so
this might not matter to you. Yes, the hernia rate may be higher with an
open procedure (although I question the 30% always quoted), however if
given a choice of potential complications, I would choose the hernia which
has a much lower morbidity rate than a post op leak. Just my very limited 2
cents worth. Good luck! Shelley
— Shelley.
June 23, 2004
I had RNY Lap and I was out in less than 45 minutes, but my surgeon
developed the Lap procedure (Dr. Alan Wittgrove at Alvarado in San Diego)
so I guess he's had some practice!! That's actually why I chose him.
I've heard that Lap can actually be longer due to the difficulty of the
procedure, but if your surgeon has had a lot of practice with it, it will
go much faster. Ask him what the average Lap time is. Or ask the office
when you call for information--they should be able to tell you with no
problems.
This sounds weird, but I've heard that some people choose Open over Lap
because not because it's usually shorter, but because they were hoping for
hernias so they could get their tummy tucked at the same time as the hernia
operation. Please don't choose it for that! Ask your surgeon--in fact ask
many surgeons---what their average time is on Lap and if there are any
benefits to getting it open (I personally don't know of any, but you never
know!). Either way, I'm sure you'll be a great success, this is a
wonderful procedure! Best of luck!
— susannahs
June 23, 2004
The lap has a lower rate of complications compared to open. Period. No
hernias, and very, very little incidence of leaks. However, it may not be
the shortest, depends on the skill of the surgeon. With open you spend
more time recovering, after all you have a larger scar, than with lap. With
lap the surgeon sees much better (don't be fooled by surgeons who say they
can see better when you are opened up). The naked eye cannot see to the
power of magnification that the lap instruments can. Open surgeries are
performed by surgeons who are not skilled in lap procedures. When I
searched for a surgeon, and knew I wanted lap, I chose a surgeon who was
very skilled in lap procedures. Having had both open and lap surgeries, I
can tell you, the recovery time from lap is soooo much quicker.
— Cindy R.
June 23, 2004
I hate to quibble with my Esteemed Workout Buddy (hi Cindy!), but I'm not
aware that the incidence of leaks is less for lap than for open -- so far
as I know, the biggest, most classic, inarguable difference between the
two, compliation-wise, was that "opens" had a far greater risk of
hernias. However, I recently saw an article noting that laps often wind up
with very difficult to diagnose, deeply internal hernias, which are not a
particular risk with opens. Being an open, I thought, Ah HA! I can
finally say something back to all those hernia-minded lap
people!<P>My silliness aside, my impression is that surgeons will do
the procedure in which they are most experienced and best trained, meaning,
better to have a surgeon who has done 2,000 opens do an "open" on
you, than let one who has done 50 laps do a "lap" on you (or vice
versa, though I can't imagine why vice versa would happen all that often).
I don't think it's really so much a question of what they "see,"
as it is which way they're most comfortable operating (as there are good
arguments either way on who sees more than who, depending on what the heck
you're lookin' for here).<P>I had open because that's all my surgeon
does, and he's now done it over 3,000 times, and most important, he had a
good aftercare program (lifetime checkups included in original surgery
price, weekly support groups he wants you to attend for at least the first
six months). If he'd have done lap that much, sure that would've been
nice, but since I had no leak, no hernia, and a 3-inch open scar that's
disappeared (and is coming out with my plastics anyway), hey, it worked out
okay here.
— Suzy C.
June 23, 2004
It is my understanding according to my surgeon who does both, that there is
more occurance of a leak with LAP and that LAP takes longer. He said I did
not have to have an NG tube for the simple fact that I had open and they
are more concerned with leaks post LAP. My recovery was very quick with
open and I had little pain. It's very conflicting. I think there are plus
and minuses with both. I would choose a surgeon you like best first, then
go with their recommendation (and probably what they practice most)
— emilyfink
June 23, 2004
I had Lap RNY and have not had any complications. It is my understanding
that there are "less" leaks with Lap surgery. My surgeon would
only perform Lap surgeries if the patient was under 400 lbs or right at it.
I had lost 16 1/2 lbs on the 10 day pre-op diet so that put me at 391 1/2.
I weighed 408 before surgery. He also told me that it depended on the
thickness of the stomach wall and muscles where Lap & open were
concerned. Honestly, I haven't had nay leaks and 10 months out have lost
140 wonderful lbs!!!!! Best Wishes to you!
— shelby J.
June 23, 2004
Dr Philip Schauer world known for bariatric surgery and my doc says....
Opens get incisional hernias at about a 30% rate, LAP near zero. Opens get
more infections, what with that big incision letting room air into your
insides. LAP were pressurized with sterile nitrogen. leak rate is about the
same. We dont wake up with a NG tube:) My surgeon transects and oversews
all stomachs. Table time is about the same, my wife a super morbid 1.5
hours. <P> He also says the key is using a EXPERIENCED LAP surgeon,
preferentially a high volume one at a teaching hospital. This adds safety,
as my surgeons group death rate is .4% much less than the national average
of about 1% Experience helps prevent troubles and identify small ones
before they become BIG troubles
— bob-haller
June 24, 2004
My friend had the open and I had the lap. She now wishes she'd had the
lap. My surgery took an hour and a half. Dr. said lap is easier because
you don't have to shift the organs around to see what you are doing, you
just rotate the camera and get a better view of what's going on. At 6
months post-op you can hardly see my 5 quarter inch scars. At almost 5
years post op, my friend has a huge "zipper" scar down her
stomach. I don't regret my choice for a minute.
— boonikki29
June 24, 2004
I'm not sure it is a want more of a have to any respictable Dr. would not
do a laparosopy surgery on someone with a BMI above 55 theres no room to
work
— mrmrsbigdog
June 24, 2004
Actually, skilled laparoscopic surgeons such as the Drs. Rabkin in San
Francisco successfully perform laparoscopic surgery -- usually the more
difficult DS surgery, in fact -- on almost all of their patients over 600
lbs. The issue is the surgeon's skill and whether they have appropriate
surgical instruments for very large abdomens. To assert that their
reputation is questionable because they are more skilled than most surgeons
is ridiculous.
— [Deactivated Member]
June 24, 2004
Todd my wifes BMI was over 60 at the time of surgery. completed in 1.5
hours. As others have stated its a matter of tools and experience. I THINK
my surgeons heavies LAP was near 700 pounds. These skills do exist, wish
they were available everywhere
— bob-haller
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